895 ROLE FOR PULMONARY METASTASECTOMY WITH A CURATIVE INTENT IN PATIENTS WITH METASTATIC UROTHELIAL CARCINOMA

Abstract

INTRODUCTION AND OBJECTIVES: Recent studies showed therapeutic benefit from lymphadenectomy in advanced stage urothelial carcinoma of the upper urinary tract (UCUUT). However, there is still a lack of prospective studies and standardization of the extent of lymphadenectomy. We conducted this multi-institutional prospective study to further examine the role of lymphadenectomy in UCUUT. METHODS: From January 2005, we performed lymphadenectomy in 82 patients at the time of radical nephroureterectomy for curative purposes as a prospective study in both institutes. These lymphadenectomies were performed in all patients except those with severe co-morbidity by exactly following the anatomical template determined from the mapping study (Pros-CompLND). These results were compared with those from 203 patients who underwent curative surgery except for Pros-CompLND in Tokyo Womenufs Medical University. We classified these patients into three groups: the patients in whom all regional sites were dissected before 2005 (Retro-CompLND), those in whom lymphadenectomy did not include all regional sites (IncompLND), and those without lymphadenectomy (No-LND). This study protocol was approved by the institutional review board of each institute. RESULTS: Mean follow-up period was 26.8 19.3 months in 82 Pros-CompLND patients, 99.7 62.4 months in 40 Retro-CompLND, 73.4 64.5 months in 45 IncompLND, and 48.5 49.1 months in 118 No-LND patients. The number of lymph nodes was significantly higher in Pros-CompLND (14.5 6.6) than in Retro-CompLND (8.5 5.6) and IncompLND (4.6 2.8) (p 0.001). We examined cancer-specific survival (CSS) in the non-metastatic patients with pT2 or higher. In 121 patients with renal pelvic cancer, 3-year CSS was 87.9% in ProsCompLND, 90.8% in Retro-CompLND, 68.9% in IncompLND, and 64.7% in No-LND. CSS of Pros-CompLND and Retro-CompLND was significantly better than that of No-LND (p 0.04, p 0.01). In contrast, CSS of 69 patients with ureteral cancer was not significantly different between Pros-CompLND, Retro-CompLND, and No-LND. CONCLUSIONS: This multi-institutional study further supports the therapeutic role of template-based lymphadenectomy in patients with advanced stage renal pelvic cancer. Source of Funding: None